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M <br /> APPLICATION -- LOT LINE ADJUSTMENT <br /> �- =< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> QCipp'R <br /> L <br /> L <br /> AUTHORIZATION SIGNATURES <br /> rtheOwnerlAgent <br /> WNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. + <br /> agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> any claim, action or proceeding against the Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> Legal agent (attach proof of the owner's consent to the application of the property's involved in this <br /> application and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: /C'(J!7 /�r � Signature: ' <br /> �'- <br /> Print Name: Signature: <br /> Date- <br /> Print Name: Signature: <br /> Date_ <br /> Print Name: Signature- <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> i <br /> F:IDEVSVCWJarining Application Formsi Page 5 of 7 <br /> Loi Line Adjustment.doc.(Revised 6-4-04) l <br />